Burn Admissions Research Articles

Pediatric Burn Unit Admission is Associated with School Holidays and Lower Home Childhood Opportunity Level.

Burn injury can have profound detrimental effects on quality of life and mental health of children. We collected demographics, burn etiology, burn date, and home zip code for pediatric patients admitted to our burn unit from 2016-2023. Age, burn date, and etiology of burn were used to assess temporal and mechanistic patterns of injury for pre-school-age and school-age children. Home zip code was used to determine each child's home Childhood Opportunity Index score, which is composed of sub-domains for Education, Health & Environment, and Social & Economic. We calculated the odds-ratio for odds of pediatric burn admission for each COI sub-domain quintile, using very high opportunity neighborhoods as the reference. Scald was the prevailing burn etiology (64%). In school-age children, July was the month with the most burn injuries (19%), attributable to firework injuries. School-age children were also more likely to be injured in a week without classroom instruction (p<0.001). There was a dose-response relationship between Childhood Opportunity Index and odds of burn admission, with the greatest odds of burn admission observed for children from very low educational opportunity areas (OR 5.21, 95% CI 3.67-7.39). These findings support interventions for burn prevention such as increased education about the dangers of fireworks, addressing inequities in access to childcare and extracurricular activities, and reducing the default water heater temperatures in multi-unit dwellings.

Evaluation of a National Sample of 16,671 Pediatric Burn Admissions: Identifying Predictors of Non-accidental Pediatric Burns

BackgroundBurn injuries remain one of the leading causes of injury and death in children. Studies have demonstrated a higher mortality for pediatric burns associated with non-accidental injury. Using data from a burn registry, our study aimed to discern potential factors associated with non-accidental burn injuries. MethodsWe utilized the American Burn Association database from 2016 to 2018, which collects data from over one hundred burn centers across the United States, to evaluate a large pediatric burn population. Patients aged ≤14 years were analyzed. The population was then divided into suspected non-accidental versus accidental burn injuries. A multivariable logistic regression model was utilized to evaluate for predictors of burn injuries. Additional models were used to assess the relationship between suspected non-accidental burn injury and mortality, intensive care unit (ICU) stay, and hospital length of stay. Results16,671 pediatric patients were included. Of those, 1228 (7.4%) patients suffered non-accidental burn injury. A majority of children who sustained non-accidental burn injury were younger, non-white, and sustained scald burns. The regression model demonstrated predictors for non-accidental burn injuries included younger age, Black race, chemical/corrosion burns, government insurance, and increased total body surface area (TBSA) burn. Overall mortality for the population was 0.5%. ConclusionThis evaluation of a national burn registry reveals differences in pediatric patients sustaining non-accidental burns compared to accidental burns. The findings in this study identify pediatric populations at risk for suspected non-accidental burn injuries which may assist in preparing the families for expectations after admission for a burn injury. Level of EvidenceIII.

Clinical prediction of wound re-epithelisation outcomes in non-severe burn injury using the plasma lipidome

Whilst wound repair in severe burns has received substantial research attention, non-severe burns (<20% total body surface area) remain relatively understudied, despite causing considerable physiological impact and constituting most of the hospital admissions for burns. Early prediction of healing outcomes would decrease financial and patient burden, and aid in preventing long-term complications from poor wound healing. Lipids have been implicated in inflammation and tissue repair and may play essential roles in burn wound healing. In this study, plasma samples were collected from 20 non-severe burn patients over 6 weeks from admission, including surgery, and analysed by liquid chromatography-tandem mass spectrometry and nuclear magnetic resonance spectroscopy to detect 850 lipids and 112 lipoproteins. Orthogonal projections to latent structures-discriminant analysis was performed to identify changes associated with re-epithelialisation and delayed re-epithelisation.We demonstrated that the lipid and lipoprotein profiles at admission could predict re-epithelisation outcomes at 2 weeks post-surgery, and that these discriminatory profiles were maintained up to 6 weeks post-burn. Inflammatory markers GlycB and C-reactive protein indicated divergent systemic responses to the burn injury at admission. Triacylglycerols, diacylglycerols and low-density lipoprotein subfractions were associated with delayed wound closure (p-value <0.02, Cliff’s delta >0.7), whilst high-density lipoprotein subfractions, phosphatidylinositols, phosphatidylcholines, and phosphatidylserines were associated with re-epithelisation at 2 weeks post-surgery (p-value <0.01, Cliff’s delta <-0.7). Further model validation will potentially lead to personalised intervention strategies to reduce the risk of chronic complications post-burn injury.

Mobilization With Femoral Catheters in the Burn ICU: A Retrospective Review Following Change in Practice Guidelines.

Femoral catheters are commonly viewed as a barrier to Burn ICU mobility progression due to anatomical location and potential risk of complications. The purpose of this review was to examine outcomes and complication rates following implementation of femoral catheter mobilization guidelines, as well as determine safety and feasibility of mobilization with femoral catheters in place within the burn population. A retrospective review was completed on 17 patients prior to and following the implementation of new femoral catheter mobility guidelines, 34 patients total. Burn therapy notes were reviewed for burn admissions with at least 1 femoral catheter in place, including arterial, central, and dialysis catheters. Demographic data, admission statistics, line placement timelines, and active mobility achieved during therapy sessions were recorded for both the nonmobilization group (NMG) and mobilization group (MG). The 34 patients reviewed had 99 total lines placed (30 NMG, 69 MG). Change in mobility protocols for the MG resulted in more therapy sessions (n = 516 vs 281) and a significant increase in active mobility sessions (n = 83 vs 5, P < .001), including 146 total mobility activities such as transitions to chairs, tilt table, sitting edge of bed, standing, active chair transfers, ambulation, and cycle ergometry. No catheter-associated adverse events occurred during active mobility sessions and no complications were associated with participation in mobility. This review supports that the presence of femoral catheters alone should not limit the progression of mobility interventions with the use of clinical judgment in specialty-trained burn therapists.

Burn Care Funding in the Era of Price Transparency-Does Verification Signal Bargaining Power?

The Price Transparency Rule of 2021 forced payors and hospitals to publicly disclose negotiated prices to foster competition and reduce the cost. Burn care is costly and concentrated at less than 130 centers in the US. We aimed to analyze geographic price variations for inpatient burn care and measure the effects of American Burn Association (ABA) verification status and market concentration on prices. All available commercial rates for 2021-2022 for burn-related diagnosis-related groups (DRGs) 927, 928, 929, 933, 934, and 935 were merged with hospital-level variables, ABA verification status, and Herfindahl-Hirschman Index (HHI) data. For the DRG 927 (most intensive burn admission), a linear mixed effects model was fit with cost as the outcome and the following variables as covariates: HHI, plan type, safety net status, profit status, verification status, rural status, and teaching hospital status. Random intercepts allowed for individual burn centers. There were 170,738 rates published from 1541 unique hospitals. Commercial reimbursement rates for the same DRG varied by a factor of approximately three within hospitals for all DRGs. Similarly, rates across different hospitals varied by a factor of 3 for all DRGs, with DRG 927 having the most variation. Burn center status was independently associated with higher reimbursement rates adjusting for facility-level factors for all DRGs except for 935. Notably, HHI was the largest predictor of commercial rates (P < .001). Negotiated prices for inpatient burn care vary widely. ABA-verified centers garner higher rates along with burn centers in more concentrated/monopolistic markets.

742 Injury Pattern Analysis to Optimize Burn Injury Prevention in the Unhoused Community

Abstract Introduction Unhoused patients represent a unique and vulnerable population of burn survivors. Burn injuries in unhoused patients are more likely to be related to assault, drug use, and mental health issues compared to the general population. Here, we explore the more specific circumstances and activities contributing to burn admissions among unhoused patients to better inform injury prevention efforts. Methods After IRB approval, the burn registry at an urban regional burn center was queried for burn admissions in unhoused adults from 2019-2022. Registry data pulled included demographics, urine toxicology, mechanism of injury, and injury subjective history. Subjective injury history was reviewed to determine more specific injury circumstances and activities during which accidental burns occurred. Demographic and mechanistic trends in burn admissions were explored via descriptive statistics. Results There were 254 admissions to the burn unit for unhoused patients. Patients were mostly male (76.8%), Hispanic (49.6%), and middle aged (IQR 33-55 years). 58.1% of patients were positive for stimulants on admission. The most common burn etiologies were open flame (27.6%), burning clothing or bedding (17.7%), and accelerants (14.2%). Most burns were self-reported accidental (69.7%), 9.8% assault, and 7.1% self-inflicted (missing = 34). Among accidental injuries, 11.3% were related to cooking, 10.1% involved cooking or using methamphetamine, 9.6% involved smoking, 7.3% were due to bonfires, and 5.6% were caused by candles. Conclusions Most burn injuries among unhoused patients were accidental. Although methamphetamine use was directly related to only a small proportion of accidental injuries, more than half of unhoused patients were positive for stimulants upon admission. Most burn injuries among unhoused patients were preventable, with many accidental injuries related to cooking, smoking, and open flames for warmth or light. Applicability of Research to Practice Analysis of admission patterns and subjective history can reveal potential interventions for preventable causes of injury. Safe consumption sites, as well as outreach efforts to educate unhoused patients about situational awareness, accelerants, safe smoking practices, and safe cooking practices may be effective tools in reducing burn admissions in this vulnerable population.

101 The Burden of Burns: An Analysis of Public Health Measures

Abstract Introduction Accurate analysis of injuries and illnesses is paramount when allocating resources for education, prevention, recovery, and research. Inconsistencies in public health reports and increased lobbying/marketing by medical nonprofits has obscured the perception of burn injury (BI) leading to inequities in healthcare access and funding of reconstruction and research. A primary example of these developments is the frequently referenced and inaccurate BI statistics. Our study aims to compare national references reporting the incidence of BI and the related sequela in the U.S. Methods The American Burn Association Burn (ABA) Injury Summary Report (BISR), ABA Fact Sheet, Centers for Disease Control and Prevention (CDC) Web-based Injury Statistics Query and Reporting (WISQARS) database, the CDC National Center for Health Statistics’ National Hospital Ambulatory Medical Care Survey (NHAMCS), and the commercially available claims databases were queried for 2020 burn admissions and emergency department (ED) visits. Non-U.S. reports, claims, or analyses were excluded from our review. The costs of BI were reported in U.S. dollars where available. Claims analyses were conducted using ICD-10 BI codes coupled with burn DRG for admission, and CPT for surgical intervention from a commercially available database incorporating managed care, Medicare, and Medicaid payors. Results The ABA Fact Sheet reported 486,000 BI annually. The 2021 ABA BISR data represented burn admissions at approximately 100 burn centers (BC) excluding non-BC, ED, and BC not participating in BCQP. CDC’s WISQARS database reported 3,529 burn-related deaths resulting in 45,135 years of potential years of life lost, 287,926 non-fatal BI from fire/flame and contact with 76.1% of patients treated in ED only and total costs of $42.4B. Mechanisms such as scald, chemical, electrical, radiation, and inhalation injury were not included. The CDC NHAMCS reported 359,000 BI presenting to ED (23% increase from CDC WISQARS). Our analysis from claims databases demonstrated over 698,555 BI as the primary code likely underreporting self-pay/uninsured, military facilities, and endowment or community-based hospitals not submitting claims data. Conclusions Our study demonstrates a large variability in the incidence of BI. Given the increased population noted in the U.S. 2020 census, the true number of BI is likely closer to the claims database suggesting a substantial misunderstanding in the burden of burns. We additionally noted no ICD-10 codes to characterize the sequela of BI limiting our assessment of post-acute burn care challenges. Future efforts to improve CDC reporting policies and new ICD-10 codes capturing BI sequela are essential to improve advocacy and understanding of our patients and their healthcare needs. Applicability of Research to Practice This abstract will help clinicians, patients, and investigators better advocate for population health research in burn injury.

729 The Impact of Alcohol Use on Recreational Burn Admissions from Campfires and Bonfires

729 The Impact of Alcohol Use on Recreational Burn Admissions from Campfires and Bonfires

47 Pediatric Burn Admissions: Where and When Matters

47 Pediatric Burn Admissions: Where and When Matters

506 Methamphetamine Intoxication and Inpatient Outcomes for Burn Patients

Abstract Introduction Methamphetamine intoxication frequently complicates inpatient burn admissions. While single-institution studies describe adverse outcomes during resuscitation, less is known about the associated inpatient complications and perioperative management in users. This analysis aims to identify these trends on a national level. Methods The US National Trauma Data Bank was queried to identify burn patients between 2017-2021. Methamphetamine intoxication was identified on admission and compared to those who screen negative. Primary outcomes included death, stroke, and myocardial infarction (MI). Secondary outcomes included organ failure, timing of surgery, admission vitals, length of stay (LOS), and days in the intensive care unit (ICU). Multivariable regressions modeled the effects on outcomes adjusting for available covariates including demographics, total body surface area (TBSA) burned, and inhalation injury. Bonferroni adjustments were applied. Results 326,614 burn encounters were identified, and 5,380 (1.7%) had positive methamphetamine drug screens upon admission. Users were significantly older (35.2 versus 31.9 years, p &amp;lt; .001), had a greater percentage of males (85.3 vs. 82.0, p &amp;lt; .001), were more likely to have inhalation injury and overall had larger %TBSA burns (16% vs. 13%, (p &amp;lt; .001). Users had significantly higher but clinically insignificant ED systolic blood pressures (132.1 vs. 129.9, p &amp;lt; .001). There was no significant difference between the two groups regarding pulse rate &amp;gt;120 (1.7% vs. 1.6%, p=.611). Users were not more likely to die, sustain an MI, or stroke during admission. In contrast, users were significantly more likely to have alcohol withdrawal (0.8% vs. 0.5%, p=.019), drug withdrawal (0.3% vs. 0.2%, p=.003), a pulmonary embolism (PE) (0.9% vs. 0.7%, p=.039), and delirium (1.2% vs. 0.4%, p=.003). Users had longer times to surgery adjusting for burn severity and demographics (1.6 vs. 1.4 days, p=.033). There were no significant differences in the average number of wound coverage procedures (1.50 vs. 1.45, p=.947). Users had significantly longer hospitalization (8.7 vs. 6.2 days, p &amp;lt; .001); however, there was no significant difference between days in the ICU (6.7 vs. 6.4 days, p=.072). Conclusions While not associated with mortality, methamphetamine intoxication was associated with an increased risk of many complications including PE, drug withdrawal, and delirium. Methamphetamine use was associated with delays in surgery and hospitalization. Applicability of Research to Practice Recognize the increased risk of complications and the need for tailored perioperative care for methamphetamine users. Additionally, burn centers may consider how to avoid delaying care for users and support interventions for withdrawal.

The Burden of Burns: An Analysis of Public Health Measures.

Accurate analysis of injuries is paramount when allocating resources for prevention, research, education, and legislation. As burn mortality has improved over recent decades, the societal burden of burn injuries has grown ambiguous to the public while a scarcity of investigational funding for survivors has led to a gap in understanding lifelong sequela. We aim to compare national references reporting the incidence of burn injuries in the United States. The American Burn Association Burn Injury Summary Report (ABA-BISR), American Burn Association Fact Sheet, Centers for Disease Control and Prevention (CDC) Web-based Injury Statistics Query and Reporting (WISQARS) database, the CDC National Center for Health Statistics' National Hospital Ambulatory Medical Care Survey (NHAMCS), National Inpatient Sample (NIS), National Emergency Department Sample (NEDS), and commercially available claims databases were queried for 2020 or the most recent data available. The BISR estimated 30,135 burn admissions in 2022. The 2016 ABA Fact Sheet reported 486,000 burns presented to US emergency departments (ED). In 2020, CDC's WISQARS database reported 3,529 fatal, and 287,926 non-fatal, burn injuries. The 2020 NEDS reported 438,185 ED visits while the 2020 NIS estimated 103,235 inpatients. The NHAMCS reported 359,000 ED visits for burn injuries in the same period, and an analysis of ICD-10 burn codes demonstrated over 698,555 claims. Our study demonstrates a large variability in the reported incidence of burn injury by the ABA, CDC, national samples, and claims databases. Per our analyses, we estimate that 600,000 individuals annually suffer a burn injury which merits emergent care in the United States.

Neighborhood child opportunity is associated with hospital length of stay following pediatric burn injury

IntroductionPediatric burns are associated with socioeconomic disadvantage and lead to significant morbidity. The Child Opportunity Index (COI) is a well-validated measure of neighborhood characteristics associated with healthy child development. We sought to evaluate the relationship between COI and outcomes of burn injuries in children. MethodsWe performed a single-institution retrospective review of pediatric (<16 years) burn admissions between 2015 and 2019. Based on United States residential zip codes, patients were stratified into national COI quintiles. We performed a multivariate Poisson regression analysis to determine the association between COI and increased length of stay. Results2095 pediatric burn admissions occurred over the study period. Most children admitted were from very low (n = 644, 33.2 %) and low (n = 566, 29.2 %) COI neighborhoods. The proportion of non-Hispanic Black patients was significantly higher in neighborhoods with very low (44.5 %) compared to others (low:28.8 % vs. moderate:11.9 % vs. high:10.5 % vs. very high:4.3 %) (p < 0.01). Hospital length of stay was significantly longer in patients from very low COI neighborhoods (3.6 ± 4.1 vs. 3.2 ± 4.9 vs. 3.3 ± 4.8 vs. 2.8 ± 3.5 vs. 3.2 ± 8.1) (p = 0.02). On multivariate regression analysis, living in very high COI neighborhoods was associated with significantly decreased hospital length of stay (IRR: 0.51; 95 % CI: 0.45–0.56). ConclusionChildren from neighborhoods with significant socioeconomic disadvantage, as measured by the Child Opportunity Index, had a significantly higher incidence of burn injuries resulting in hospital admissions and longer hospital length of stay. Public health interventions focused on neighborhood-level drivers of childhood development are needed to decrease the incidence and reduce hospital costs in pediatric burns. Type of studyRetrospective study Level of evidenceLevel III

Burnt out: A retrospective review of paediatric burns admissions at Chris Hani Baragwanath Academic Hospital 2015–2020

BackgroundBurn injuries in children in low- and middle-income countries are common, serious, and preventable. Despite the high burden of disease, there is a paucity of data on the profile of paediatric burns in South Africa. Such data are essential to local burn prevention strategies. MethodsA retrospective review of all recorded paediatric burns admissions to the paediatric burns unit at Chris Hani Baragwanath Academic Hospital was performed from 1 January 2015 – 31 December 2020. Ethical approval was obtained. Data extracted anonymously included patient age, sex, mechanism of injury, injury severity, date of injury and residential location. ResultsA total of 2980 admissions occurred during the study period. Infants ≤ 1 year accounted for 42.2 % (1259/2980), males 61.4 % (1689/2751), hot water burns 79.1 % (2357/2980), and major injury 40.1 % (1201/2980) of admissions. Most burn injuries occurred in winter (28.2 %, 842/2980), and most admitted patients lived in Soweto 45.5 % (1355/2980). ConclusionsMost burns admissions in the study period were characterised by male children less than one year of age, hot water burns, major burn injuries and admissions in the winter months. These results are similar to national and international data regarding age, sex, mechanism of injury and seasonality of paediatric burns. The results from the study have been utilised to inform Surgeons For Little Lives’ paediatric burns prevention campaigns in Soweto and Gauteng Province.

Injury Pattern Analysis to Optimize Burn Injury Prevention in the Unhoused Community.

Unhoused patients are an overrepresented group in burn injury, and are a uniquely vulnerable population. Current research focuses on the consequences of homelessness on burn outcomes, with little known about the specific circumstances and behaviors leading to burn injury that may represent specific targets for injury prevention efforts. The burn registry at an urban regional burn center was queried for burn admissions in unhoused adults from 2019 to 2022. Registry data pulled included demographics, urine toxicology, mechanism of injury, and injury subjective history. Subjective injury history was reviewed to determine more specific injury circumstances and activities during which accidental burns occurred. Demographic and mechanistic trends in burn admissions were explored via descriptive statistics. Among 254 admissions for burns from the unhoused community, 58.1% of patients were positive for stimulants on admission. Among accidental injuries (69.7%), common circumstances included preparing food or beverages, cooking or using methamphetamine, smoking cannabis or tobacco, bonfires, and candles. A specific common circumstance was lighting a cigarette while handling accelerants (6.7%). Interventions for stimulant abuse, as well as outreach efforts to educate unhoused patients about situational awareness, safe handling of accelerants, safe smoking practices, and safe cooking practices, may be effective tools in reducing burn admissions in this vulnerable population.

Advanced Orotracheal Tube Fixation Techniques in Severe Burn Patients: Innovations from a Chilean Hospital

Since its foundation, the Hospital Emergency Public Assistance in Santiago, Chile, has been the national reference center for managing severe burn patients. In 2007, more than 6,000 hospital admissions for burns were registered in Chile due to the severity of the clinical condition. These patients must be treated in intensive care units. Therefore, the use of orotracheal tubes is essential for its management. The correct stabilization of these devices avoids complications or airway risks. In the Major Burn Unit, cotton cloth restraints and transpore-type adhesives are used on the user's face, but in patients with facial territory compromise, these cause tissue damage; due to this, the Dental Unit has innovative techniques of orotracheal tube fixation, using stainless steel and plastic wire ties, which have allowed to reduce the risks of extubation and accidental displacement of the tube, improving its stability. This work describes the technique used in orotracheal tube fixation in two patients with severe burns, performed by the Dental Unit of the Hospital Emergency Public Assistance, Dr. Alejandro del Río, Chile.

Factors Predicting 90-Day Readmissions for US Older Adult Burn Patients From the 2016-2018 Nationwide Readmissions Database.

Older adults with burn injuries have a high risk of readmission after the initial burn admission. Frailty is associated with poor outcomes from the initial burn injury, however, it remains unknown if frailty impacts readmission in older adults after the initial index burn admission. Our study aims to examine patient, frailty, burn, surgical, and hospital factors that contribute to 90-day readmissions in older adults with an acute burn. Patients ≥ 50 years of age with an acute burn diagnosis in the Nationwide Readmissions Database (2016-2018) were included. Patients who died during index admissions were excluded from the readmission analysis. Patient, burn, hospital stay, and hospital characteristics were analyzed. Using variables significant from univariate logistic regression analysis, we performed a multivariable logistic regression analysis to identify factors associated with 90-day readmissions. A total of 41,500 weighted index burn admissions were included. The 90-day readmission rate was 25.6% (10,641/41,500). Almost all the readmissions were unplanned (96.5%). The most common primary readmission diagnoses based on Clinical Classifications Software Refined were burn injury and septicemia. Multivariable logistic regression analysis demonstrated an increased hospital frailty risk and lower-body-only burns were associated with an increased risk of readmission. Notably, surgical treatment of the burn injury during the index admission was associated with a decreased risk of readmission. This highlights the importance and challenges of surgical decision-making for older adults with high comorbidity burden. Future studies are needed to develop decision guides to help clinicians identify patients who would benefit from surgical treatment versus more conservative strategies in older adult patients with burns.

Inpatient Complications and Outcomes for Burn Patients Admitted With Methamphetamine Intoxication.

Methamphetamine intoxication frequently complicates inpatient burn admissions. While single-institution studies describe adverse outcomes during resuscitation, little is known about the risks of amphetamine intoxication on inpatient complications and perioperative management. The US National Trauma Data Bank was queried for burn encounters between 2017 and 2021. Amphetamine intoxication was identified on admission. Primary outcomes included death, stroke, and myocardial infarction (MI). Secondary outcomes included organ failure and surgical management. Multivariable regressions modeled outcomes adjusting for available covariates including demographics, TBSA burned, and inhalation injury. Bonferroni adjustments were applied. Our study identified a total of 73,968 primary burn encounters with toxicology screens. Among these, 800 cases (1.1%) were found to have positive methamphetamine drug screens upon admission. Methamphetamine users were significantly older (41.7 vs 34.9 years, P < .001), had a greater percentage of males (69.6 vs 65.4, P = .045), were more likely to have inhalation injury (P < .001), and had larger %TBSA burns (16% vs 13%, P < .001). Methamphetamine users were no more likely to die, experience MI, or experience stroke during admission. In contrast, methamphetamine users were significantly more likely to have alcohol withdrawal (P = .019), acute kidney injury (AKI) (P < .001), deep vein thrombosis (P = .001), pulmonary embolism (PE) (P = .039), sepsis (P = .026), and longer intensive care unit (ICU) stays (P < .001). Methamphetamine use was associated with a longer number of days to the first procedure (P = .005). Of all patients who required surgery (15.0%), methamphetamine users required significantly more total debridements and reconstructive procedures (P < .001). While not associated with mortality, methamphetamine intoxication was associated with an increased risk of many complications including PE, deep vein thrombosis, AKI, sepsis, and longer ICU stays. Methamphetamine intoxication was associated with delays in surgical care.

Time series of hospital admissions for burns in pediatric patients in the Southern Region of Brazil in the period from 2016 to 2020

Time series of hospital admissions for burns in pediatric patients in the Southern Region of Brazil in the period from 2016 to 2020

Burn and Trauma Burden and Screening for Interpersonal Violence During the COVID-19 Pandemic

IntroductionNationwide shelter-in-place (SIP) orders during the pandemic have had long-lasting effects, including increased rates of domestic violence and interpersonal violence. Screening for violence varies by institution, which tool is used, and when. Given increases in burn and trauma admissions over the course of the pandemic, we sought to examine trends at our institution during this time period to better guide care and anticipate system-level effects. MethodsWe performed a retrospective cohort study of pediatric burn and adult burn and trauma patients at our level 1 trauma/burn center between March-May 2019 and March-May 2020. Home safety screening was performed by nursing staff using a 1-part screening questionnaire. Patients presenting before March 15, 2020, were defined as “pre-SIP; ” between March 16-May 19, 2020, were “during SIP; ” and those after May 19, 2020, were designated as “post-SIP.” Descriptive and chi-square statistics were used. Demographic, injury patterns, and screening information were collected. ResultsBlunt trauma comprised 60% of injuries, followed by burns (30%) then penetrating injury (7%). Over the entire time period analyzed, 1822 patients had documented home safety screening; ∼2% of patients screened reported a safety concern pre-SIP, compared to 3% of patients during SIP. There were higher rates of burns and penetrating injury during SIP compared to other periods (P ≤ 0.0001). Home safety screening rates were 94%-95% pre- and during SIP, but dropped to 85% post-SIP (P < 0.0001). Home safety concerns were reported almost 2% of the time pre-SIP and 3% during SIP (P = 0.016). ConclusionsWe noted an increase in trauma and burns during and after SIP orders, consistent with the experiences of other institutions. Implementation of a nurse-driven screening process demonstrated high compliance with appropriate referrals. The burden of burn and traumatic injury remains significant, highlighting a need for continued psychosocial screening and the provision of psychosocial support resources in the acute trauma setting.

Fragmentation of Care After Admissions for Burn: An Analysis of the National Readmissions Database

IntroductionBurn patients require complex longitudinal care guided by a team with specific clinical expertise. Burn patients are at increased need for readmission, which may result in Fragmentation of care (readmission to hospitals other than the index hospital), that can lead to increases in mortality, length of stay, and financial burden. In the already-complex burn patient, negative effects of care fragmentation may be magnified. We hypothesized that specific patient and demographic factors would be associated with burn readmissions and fragmentation of care. MethodsUtilizing the Nationwide Readmissions database, we identified patients admitted between January and September 2017 with a principal diagnosis of burn readmitted to any hospital within 90 d of index discharge. Demographics, total burn surface area, Elixhauser comorbidities, and index discharge disposition were collected. Primary outcome was readmission to the same hospital as the index admission. Penalized multivariable logistic regression assessed factors associated with index hospital readmission. ResultsOf 9987 burn patients who survived an index burn admission, 1082 (10.8%) were readmitted. Approximately half (51.6%, n = 558) of readmissions occurred at the index hospital. Factors associated with readmission to the same hospital were disposition to home with home health care (odds ratio: 1.42 [1.02-1.96], P = 0.037), private insurance (odds ratio: 1.63 [1.07-2.49], P = 0.022), and ZIP code income quartile >$74,000 (OR 1.87 [1.26-2.78], P = 0.002). ConclusionsDisposition home with home health care, private insurance, and a ZIP code income quartile greater than $74,000 were associated with a lower odds of having fragmentated care. Our data suggest that fragmentation of care may be potentiating a disparity for lower-income burn patients.